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Friday, February 18, 2011

Rear-Facing Car Seats

I had a request from one mum to write a piece on when you turn your baby from rear-facing to front facing. This has been the subject of some discussion in my mothers group recently.

The Legal Stuff

As of late 2009 / early 2010, all Australian jurisdictions except the Northern Territory had legislation which requires children to be in a rear-facing car seat from birth to 6 months. Britax, which makes Safe'n'Sound capsules have summaries of the requirements by State. From 6 months on, placing your baby in a forward facing car seat is legally permissible.

The Risk of Forward Facing Car Seats

The risk is that in a front-on collision, the baby's head will slam forward abruptly. Their delicate spines, which are not yet fully formed, stretch apart with the force of the heavy and fast-moving head, so their spinal cords can literally be ripped from their skulls. It is not just a matter of head strength. Just because your baby holds their head up well doesn't mean they are strong enough not to suffer this kind of injury.

Of course, a rear-facing car seat does not protect a baby in a collision from behind, but these kinds of collisions are far less severe - front-ons tend to occur when you slam into a car coming from the opposite direction, as opposed to being bumped from behind. This article quotes a study which found that children under 2 were 1.75 as likely to suffer a serious injury in a forward-facing car seat than a rear-facing car seat.

In Scandinavian countries, it is common to keep children in rear-facing car seats until age 5, and injury rates for children in these seats are significantly lower than other arrangements - although unfortunately they were compared with booster seats and seatbelts, not 5 point harness-type seats (Carlsson and Norin).

Here is a brief video with footage from crash test dummies in front and rear-facing car seats so you can see what happens:

I have not been able to find anything which suggests it is safe to turn a baby before the age of 2. Everything I have read indicates that the longer you leave them rear-facing, the better. However, in practice, many parents turn their children before 2 years of age because:

their children exceed the maximum height or weight limit of the rear-facing seat and it is no longer safe to ride in that seat; or

their children are happier riding forward-facing.

The Likelihood of Injury / Death

Talking about babies having their spines ripped apart is obviously a rather emotive topic, so before you beat yourself up for turning your baby's car seat - let's just look at the risk in context. Yes, motor vehicle accidents is a leading cause of deaths in children, but that still doesn't mean it's likely to happen to you or your baby.

I think it's important to put the risks in perspective by looking at the overall likelihood of death or serious injury as a result of car accidents.

An article published by the Australian Bureau of Statistics in 2006 indicated that 587 children aged between 0-14 yrs died between 1999-2003 as a result of motor vehicle accidents, and that in 44% of these cases (258 deaths), children were passengers in the vehicles. Only 17 of all the children who died in traffic accidents were under 1 year of age, which is pretty much exactly 1/15 of the total passenger deaths - as the 258 deaths span 15 age ranges, this means that infants under 1 year of age do not appear to be dying as passengers in car accidents any more frequently than older children. By contrast to those 17 babies under 1 who died in car accidents, 29 died by accidental drowning, 88 by choking or suffocation, and 39 from assault.

17, it must be said, is a very small number. But that is just deaths. What about injuries?

A study of Victorian accidents (Lennon et al) showed that the risk of fatality for children under 1 year of age around this time was 8.5 deaths for every 1000 accidents - so we could take an educated guess that if there were 17 deaths, there were about 500 accidents involving babies between 0 and 1. About 1/5 of all children involved in accidents resulted in hospitalisation (Lennon et al), giving an estimate of 100 hospitalisations across Australian for children under 1 year of age from motor vehicle accidents between 1999-2003 .

About 250,000 women gave birth in 2003, a fertility rate which had decreased from about 275 000 in 1999, so we would expect just over 1 million children in Australia had been between the ages of 0 and 1 at some time during that period of 17 deaths and 100 hospitalisations. Remember, these figures of 17 and 100 are drawn from all babies, including those sitting on a parent's lap or in a vehicle with no restraints at all. About 25% of children under 3 in the Victorian crashes were not wearing seatbelts or restraints (Lennon et al). Failure to wear a restraint made the risk of serious injury about 3.2 times more likely.

Making a Choice

We have a rear or front facing car seat which can take a baby up to 18kg - such seats appear to be available in Australia. One mother in my mother's group imported a rear-facing car seat which can take a child up to 25kg from Sweden.

When considering whether to turn your baby's car seat, it's important not to just consider spinal safety, but the overall risk of having an accident with the two positions. Some parents find their babies are very unhappy in the rear-facing position, and carry on in a very distracting way. I myself have almost run into a gutter once I have been so distracted by my baby's crying. (We were going round a bend, literally and metaphorically.)

On the other hand, another mum in my mother's group pointed out that she was more distracted once the baby was forward-facing, because he kept dropping his toys and they'd fall to the floor, then he whinged because he didn't have a toy.

Good article :) Although the chance of having a severe accident is relatively small, I would hate to find myself in that minority and have to live with the knowledge that perhaps my child's death or disabling injury could have been prevented by my choice of car seat. Nobody chooses or predicts that something like that will happen, so I am taking the better safe than sorry approach for as long as my son will still fit properly in a rear facing restraint. He is just over 9 months now and has never faced forward (In fact, I still have him rear facing in his strollers too - so he can see me and I can see him), so he doesn't know any different and is perfectly happy rear facing so there are no compelling reasons for us to turn him forwards.

Great article Caroline. I have also done a bit of research on this issue as i have a boy in the 97th percentile for height and weight and figured he would outgrow his baby capsule before 6 months. I found it interesting that the law only requires rear facing car seats until 6 months of age and i think this causes a lot of people to think it is safe to turn the seat to forward facing after 6 months. This is also the advice I received from a specialist baby shop that sells car seats!! The information provided on the Australian motoring organisations' websites also gives the impression that it is safe to turn the seat after 6 months. While the websites list the safety ratings of the various car seats and mention that an incorrectly fitted car seat is dangerous and convertible car seats may be safer in one position than another, nowhere does it mention that it is safest to keep your child in a rear facing seat for as long as possible. The RACV site even goes so far as to recommend a forward facing child restraint on their child restraint calculator when you say that your child is 7 months and 10kg!! With further research I found it was safest to keep your baby rear facing for as long as possible and preferably up until 2 years of age. The problem I then found was finding a suitable seat that would accommodate my larger baby. Convertible car seats that go up to 18kg either go up to 9kg or 12kg in the rear facing position and you have to check carefully which it is (they also have maximum lengths which is another problem for me). It is hard to think of everything when you are researching baby gear but I would certainly recommend buying a rear facing restraint that goes up to 12kg with a good maximum length.Hazel

Interestingly, we have a small child (premature baby that was also genetically small) and had dilemmas about turning her around too.

At 13 months (when we did finally turn her around due to tantrums and injuries to us attempting to get her in her seat) she was barely 8 kg. We agonised over it, and we made the decision that was right for us after educating ourselves about the risks.

Now at 4.5 she is about 14kg and still in the same seat she has been in from birth. We recently needed to purchase a second car seat for our other car and decided on a toddler booster (5 point harness, full back and sides), but the main seat is still her infant seat, and will be until she exceeds the size for it, regardless of age.

We had a lot of people comment that we wre (and are) being over protective.... but I think it is more that we value her life.

Reesylou, I think it's wonderful you have the confidence to make the right decision for you, regardless of what people say. Your decisions have been informed and loving - sheesh, you think people could find more useful things to criticise in this world!

Anonymous, I asked around, and a mum friend of mine says: "You can buy ERF seats from OS, that aren't called boosters as such, but can seat a toddler rear facing up to 4 plus years. The tether straps go around the base of the front seats, instead of to an anchor bolt in its normal position, or if your car has ISOFIX bolts, you can import seats that use those instead. My ERF seat goes to 25kg rear facing, and there is plenty of leg room. I bought mine from carseat.se which is based in Sweden. The guy who sells them is very knowledgable, and has a blog on the site with loads of info also."

Being Swedish and finding this blog hearing about turning your children at 2 is shocking. If you would do that here people would believe you are crazy. It is true that many children age 4 or 5 use rearfacing seats here and many parents buy another rearfacing seat if the child outgrows the first one. It is common to have a smaller seat like a Britax Highway or Brio Zento as a first chair and a Britax Twoway as second chair and then once both are outgrown buy a boosterseat. Outgrown is usually by length and not from reaching 25 kg so that is why you might need two chairs.

Frontfacing in a combination chair though legal is not advised by experts as the combination chairs are fairly heavy. However, it is of course always better than no chair at all for a child that is not tall enough to sit with just a belt. I bought a Brio Zento for my daughter and depending on her size and if we manage to have another baby we will probably use a Twoway as well before buying a booster. This is not me being extremely cautious, this is normal here. Extremely cautious is the parents who buy cars with reversible seats (the actual seat of the car) for when the child only fits into a booster. That is a bit over the top in my view and way too expensive.

Another Swede here, and I can only agree with Elin Hagberg! It is crazy to turn your child around at the age of 2! There are very few cases (extreme motion sickness for example) where I would think it was ok.The norm here is to have a child RF until about 4 yo. The people, minority, that turn the kid around are usually the ones with severe problems with the child having motion sickness, and the other category being parent that do not understand how much safer it is. Many think that the child's physical size determine how well they cope in a crash, but the bones and neck muscles development are not related to size, but instead age. And for the children to have a fairly good chance of coping with a head on collision they should be at least 4 years old.

I am somewhat glad that Australia is now (it seems) changing the standards to allow ISOFIX, and also to allow for children to about 2-3 years old. But it is so sad that Australia is so far behind. No seats yet, and 2-3 should be 4-5!

Last time we visited family in Australia we had a daughter at 17 months old. We rented a seat that allowed up to 12 kilos RF, and kept her RF in that even though she was 13 kilos.

Next trip is in November this year, and now we have a son that will be 13 months, and he's a big boy. Again it looks like we will have to break the law in order to have our child as safe as possible in the car. That's just so sad...